The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan

Fukuda, Haruhisa; Ikeda, Shunya; Shiroiwa, Takeru; Fukuda, Takashi

doi:10.1007/s40273-016-0402-3

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…It has been reported that medical costs for an individual with one diabetes‐related complication can be 1.2 times higher than that of an individual without any complications, and this increases by 1.8, 2, and 2.5 times when the number of complications increases to 2, 3, and 4, respectively 112 . It has also been reported that the average cost per‐patient‐per‐month associated with diabetes is estimated to be US$208 (95% CI, 207‐209) in Japanese patients using the JMDC data 113 . Retinopathy and renal failure add additional costs of US$97 and US$340, respectively.…”

Section: Recent Diabetes Studies In Japanmentioning

confidence: 99%

“…112 It has also been reported that the average cost per-patientper-month associated with diabetes is estimated to be US$208 (95% CI, 207-209) in Japanese patients using the JMDC data. 113 Retinopathy and renal failure add additional costs of US$97 and US$340, respectively. These costs increase to US$2062 with retinopathy and US$3689 with renal failure when surgery or dialysis is performed.…”

Section: Diabetes-related Healthcare Costsmentioning

confidence: 99%

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Current trends in diabetes mellitus database research in Japan

Kohsaka

Morita

Okami

et al. 2021

Diabetes Obesity Metabolism

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With the widespread use of electronic medical records and administrative claims databases, analytic results from so‐called real‐world data have become increasingly important in healthcare decision‐making. Diabetes mellitus is a heterogeneous condition that involves a broad spectrum of patients. Real‐world database studies have been recognised as a powerful tool to understand the impact of current practices on clinical courses and outcomes, such as long‐term glucose control, development of microvascular or macro‐vascular diseases, and mortality. Diabetes is also a major global health issue and poses a significant social and economic burden worldwide. Therefore, it is critical to understand the epidemiology, clinical course, treatment reality, and long‐term outcomes of diabetes to determine realistic solutions to a variety of disease‐related issues that we are facing. In the present review, we summarise the healthcare system and large‐scale databases currently available in Japan, introduce the results from recent database studies involving Japanese patients with diabetes, and discuss future opportunities and challenges for the use of databases in the management of diabetes.

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Section: Recent Diabetes Studies In Japanmentioning

confidence: 99%

Section: Diabetes-related Healthcare Costsmentioning

confidence: 99%

Current trends in diabetes mellitus database research in Japan

Kohsaka

Morita

Okami

et al. 2021

Diabetes Obesity Metabolism

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show abstract

“…However, this analysis was subject to limitations associated with any inaccuracies or incompleteness of the ICD-10 codes and ATC codes used to identify diagnoses and medication use as well as lack of clinical information (e.g., to assess blood glucose control). Relatedly, while the methods used to identify patients with T2DM are consistent with prior studies using the same database, the effect of alternative criteria for identifying T2DM patients on the study findings is not known [ 3 ]. In addition, HIV/AIDS information was not available in JMDC, so the CCI may not be precise.…”

Section: Discussionmentioning

confidence: 96%

“…Type 2 diabetes mellitus (T2DM), the most common form of diabetes, affected about 7.6% of adults aged 20–79 years in Japan in 2015 [ 1 ] and accounted for approximately 4% of the national healthcare expenditure in 2014 [ 2 ]. The healthcare costs are particularly high among patients who develop diabetes-related complications, as demonstrated by a Japanese claims data study in 2016 [ 3 ]. As such, it is important to effectively manage patients with T2DM in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Characteristics, Treatment Patterns, and Economic Outcomes of Patients Initiating Injectable Medications for Management of Type 2 Diabetes Mellitus in Japan: Results from a Retrospective Claims Database Analysis

et al. 2018

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IntroductionThis study’s objective was to describe characteristics, treatment patterns, and economic outcomes of type 2 diabetes mellitus (T2DM) patients initiating injectable antidiabetic medications in Japan.MethodsAdults (≥ 18 years) with T2DM, ≥ 2 claims for injectable antidiabetics between 1 August 2011 and 31 July 2015 (first claim = index date), no evidence of type 1 diabetes mellitus, ≤ 1 claim for insulin, no claims for GLP-1RA before index, and continuous enrollment for 6 months before (baseline) and 12 months after index (follow-up) were selected from the Japan Medical Center Database. Patient characteristics and outcomes during the baseline and follow-up periods were described overall and by provider, using the proxy setting of index medication [hospital (including outpatient departments) for specialists; clinic for general practitioner (GP)].ResultsOf the 2683 patients included (mean age: 50 years, 67% male), 1879 (70%) initiated injectable antidiabetics with specialists and 804 (30%) with GPs. The specialist cohort had a significantly greater comorbidity burden, but lower HbA1c levels during baseline, and was more likely to receive intensified treatment at index than the GP cohort. Almost 40% of patients (almost 30% of GP cohort) did not use antidiabetics during baseline; the remaining patients received oral medications, primarily from GPs. During follow-up, patients used the index medication for approximately 7 months. Independent of specialist vs. GP setting, patients received antidiabetics and medications for T2DM-related comorbidities and complications during the baseline and follow-up periods from the same provider, primarily GPs. The overall average healthcare costs were ¥350,404 during baseline and ¥1,856,727 during follow-up.ConclusionsIn Japan, most T2DM patients initiated injectable antidiabetics with specialists vs. GPs. There were considerable differences in characteristics of patients treated by specialists vs. GPs. After initiation, injectable antidiabetics were largely prescribed by GPs. Future research should evaluate the factors associated with different provider practices and communication channels between specialists and GPs to improve patient management.FundingEli Lilly and Co.

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“…We calculated a single utility value for those with T2DM with any complication based on multiple studies. Fukuda et al [12] thoroughly reported treatment costs for patients with T2DM and the proportion of T2DM-related complications using the Japan Medical Data Center Claims Database. We rst retrieved utility values for each T2DM-related complication from previous studies and then weighted each utility value based on the proportion reported to aggregate into one utility, which represents the average utility value for patients with T2DM with any complication (Table 1).…”

Section: Utilitymentioning

confidence: 99%

Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification.

Ohde

Moriwaki

Takahashi³

2020

Preprint

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Background: To determine the best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in a healthy population, HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness were considered.Methods: State transition models were built to study the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health population. Age was stratified into 30-44-, 45-59-, and 60-74-year-old age groups, and BMI was also stratified into underweight (<18.5 kg/m2), normal (18.5-25 kg/m2), overweight (25-30 kg/m2) and obese (≥30 kg/m2). In each model, different HbA1c test intervals were compared to evaluate costs per quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER). We compared intervals annually (current Japanese strategy), every three years (US and UK recommendations) and tailored to each risk stratification group, based on our previous work. All model parameters, including screening and treatment costs, complications and mortality rates and utilities, were applied from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY.Results: The HbA1c test interval for detecting T2DM in a healthy population varies by age and BMI. Three-year intervals were the most cost effective in obese groups at all ages—30-44: $15,034/QALY, 45-59: $11,849/QALY, 60-74: $8,685/QALY—compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60-74-year-old age groups—underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY—and in the overweight 45-59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than three years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, QALY does not show much difference among any groups.Conclusions: Annual screening to detect T2DM was not cost effective and should not apply to any population. The three-year screening interval was optimal among all elderly populations, the obese groups of all ages and the overweight 45-59-year-old group. For the low BMI and younger age groups, the optimal HbA1c test interval can be longer than three years.

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The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan

Abstract: Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.

Cited by 10 publications

References 25 publications

Current trends in diabetes mellitus database research in Japan

Current trends in diabetes mellitus database research in Japan

Characteristics, Treatment Patterns, and Economic Outcomes of Patients Initiating Injectable Medications for Management of Type 2 Diabetes Mellitus in Japan: Results from a Retrospective Claims Database Analysis

Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification.

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